title: Combining glycosylated hemoglobin A1c and fasting plasma glucose for diagnosis of type 2 diabetes in Chinese adults.
abstract: BACKGROUND
  Glycosylated hemoglobin A1c (HbA1c) has been applied to identify type 2 diabetes (T2DM) in the U.S. and European countries. It has not been used in China mainly due to lack of a standardized approach to measure HbA1c, short of knowledge about racial-specific standard and deficiency of an optimal cut-off point.
  
  
  METHODS
  To evaluate combination of HbA1c and fasting plasma glucose (FPG) in diagnosing T2DM in Chinese adults, a multistage sampling cross-sectional study was conducted in Shanghai, China, in 2009. The FPG measurement, HbA1c assay, and oral glucose tolerance test (OGTT) were performed in 6,661 Chinese adults (3057 men, 3604 women) who had no prior history of diabetes to identify the unrecognized T2DM.
  
  
  RESULTS
  A total of 454 participants were identified as T2DM based on the 1999 World Health Organization (WHO) diagnostic criteria. Of these patients, 239 were detected using an FPG ≥ 7.0 mmol/l and 141 were further identified using an HbA1c ≥ 43 mmol/mol (6.1%), achieving a sensitivity of 83.7% and a specificity of 89.3% for combining use of FPG and HbA1c. In subjects at high risk of diabetes, the combining use of FPG and HbA1c produced a higher sensitivity and an improved positive predictive value (PPV), and had a satisfactory specificity and negative predictive value (NPV).
  
  
  CONCLUSIONS
  The combining use of FPG and HbA1c is a potential screening and diagnosis approach for T2DM in Chinese adults, especially among those at high risk of the disease.
authors.affiliation: Department of Epidemiology, School of Public Health; Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, People's Republic of China. rli@scdc.sh.cn.
authors.forename: Miao
authors.initials: M
authors.lastname: Mo
authors.forename: Weijian
authors.initials: W
authors.lastname: Zhong
authors.forename: Genming
authors.initials: G
authors.lastname: Zhao
authors.forename: Ye
authors.initials: Y
authors.lastname: Ruan
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.forename: Liang
authors.initials: L
authors.lastname: Shi
authors.forename: Dajiang
authors.initials: D
authors.lastname: Lu
authors.forename: Qundi
authors.initials: Q
authors.lastname: Yang
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Li
authors.forename: Qingwu
authors.initials: Q
authors.lastname: Jiang
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.forename: Wang-Hong
authors.initials: WH
authors.lastname: Xu